renal objectives 6-and like half of 7 (tests and problems) Flashcards
1
Q
What do renal clearance tests measure?
A
They determine how much of a substance can be cleared from the blood by the kidneys in a given time.
2
Q
What can renal clearance tests help evaluate?
A
They can indirectly measure GFR, tubular secretion, tubular reabsorption, and renal blood flow (RBF).
3
Q
Why are renal clearance tests useful?
A
- Evaluating kidney function for diagnostic/prognostic purposes 2. Dosing certain medications (e.g., antibiotics) 3. Determining if a patient can undergo contrast imaging (like CT scans).
4
Q
What is Blood Urea Nitrogen (BUN)?
A
A waste product from the breakdown of protein.
5
Q
What is the normal serum range for BUN?
A
10-20 mg/dL.
6
Q
What is creatinine a waste product of?
A
Normal breakdown of muscles and it is an estimate of GFR.
7
Q
What is the normal serum range for creatinine?
A
0.7-1.2 mg/dL.
8
Q
What is creatinine clearance?
A
The gold standard estimate of GFR, comparing creatinine levels in blood and urine.
9
Q
What is the normal range for creatinine clearance?
A
90-120 mL/min.
10
Q
What is included in a urinalysis?
A
- Glucose 2. Bilirubin 3. Leukocytes 4. Nitrites 5. Ketones 6. Proteins and blood 7. Casts 8. Urine pH 9. Urine specific gravity
11
Q
What does bilirubin in urine indicate?
A
Excess bilirubin can indicate liver issues or breakdown of RBCs; it may turn the urine tea-colored.
12
Q
What do leukocytes in urine indicate?
A
Increased levels suggest a possible infection.
13
Q
What are nitrites in urine?
A
Chemicals produced from the conversion of nitrates by bacteria.
14
Q
What do ketones in urine signify?
A
They indicate fat burning; they should not be present.
15
Q
What do proteins and blood in urine indicate?
A
Possible glomerular damage.
16
Q
What are casts?
A
Tiny particles made up of white blood cells, red blood cells, kidney cells, or substances like protein or fat.
17
Q
What is the normal urine pH range?
A
4.6-8, with an ideal of 6.
18
Q
What can alterations in urine pH indicate?
A
Increased risk of kidney stones.
19
Q
What is the normal range for urine specific gravity?
A
1.001-1.005; high indicates concentrated urine, low indicates dilute urine.
20
Q
What can alterations in urine concentration indicate?
A
Complications in the loop of Henle.
21
Q
What is urinary tract obstruction?
A
A blockage of urine flow within the urinary tract.
22
Q
What can cause urinary tract obstruction?
A
Anatomic or functional defects.
23
Q
What factors determine the severity of urinary obstruction?
A
- Location 2. Completeness 3. Involvement of one or both upper urinary tracts 4. Duration 5. Nature and/or cause.
24
Q
What is the significance of upper urinary tract obstruction?
A
It can lead to more severe complications since it is closer to the kidneys.
25
What are the complications of upper urinary tract obstruction?
1. Hydroureter 2. Hydronephrosis 3. Ureterohydronephrosis 4. Tubulointerstitial fibrosis 5. Compensatory hypertrophy and hyperfunction 6. Postobstructive diuresis.
26
What is hydroureter?
Dilation of the ureters due to obstruction.
27
What is hydronephrosis?
Dilation of the renal pelvis and calyces due to obstruction.
28
What is ureterohydronephrosis?
Dilation of both the ureters and renal pelvis and calyces.
29
What is tubulointerstitial fibrosis?
Excessive deposition of collagen and proteins leading to excess cellular destruction and death of nephrons.
30
What is compensatory hypertrophy and hyperfunction?
A response that partially counteracts the negative consequences of unilateral obstruction.
31
What is postobstructive diuresis?
Fluid and electrolyte disturbances that occur when an obstruction is relieved.
32
What are kidney stones?
Masses of crystals, protein, or mineral salts that form in the urinary tract and may obstruct urine flow.
33
What are the main compositions of kidney stones?
1. Calcium oxalate and calcium phosphate (70-80%) 2. Struvite (15%) 3. Uric acid (5-10%).
34
What are the risk factors for developing kidney stones?
1. Male 2. Age (most develop before 50) 3. Inadequate fluid intake 4. Geographic location (temperature, humidity, food/fluid intake).
35
What mechanisms lead to kidney stone formation?
1. Supersaturation of one or more salts 2. Precipitation of salt from liquid to solid state 3. Growth into a stone via crystallization.
36
How does urine pH affect kidney stones?
Alkaline urine can lead to calcium phosphate stones, while acidic urine can lead to uric acid stones.
37
What are the manifestations of kidney stones?
1. Renal colic 2. Flank pain radiating to groin 3. Lower abdomen pain 4. Hematuria 5. Dysuria.
38
How is kidney stone diagnosis made?
Through history and physical examination (H&P), ultrasounds, and urodynamic tests.
39
What is neurogenic bladder?
Bladder dysfunction caused by neurologic disorders leading to problems with urine storage or voiding.
40
What occurs with upper motor neuron damage in neurogenic bladder?
Dyssynergia, which includes overactive bladder function and detrusor hyperreflexia.
41
What occurs with lower motor neuron damage in neurogenic bladder?
Detrusor areflexia, characterized by an underactive, hypotonic, or atonic bladder.
42
What are the manifestations of neurogenic bladder?
1. Frequent daytime voiding 2. Nocturia 3. Urgency 4. Dysuria 5. Poor force of stream 6. Feelings of incomplete bladder emptying.
43
What are common causes of lower urinary tract obstruction?
1. Anatomic obstructions 2. Urethral strictures 3. Prostate enlargement 4. Pelvic organ prolapse (e.g., cystocele).
44
How is urinary tract obstruction diagnosed?
Through history and physical examination (H&P), imaging studies, and urodynamic testing.
45
Upper motor neuron damage
Damage to neurons that originate in the brain and terminate in the spinal cord, affecting bladder control.
46
Dyssynergia
Overactive or hyperreflexive bladder function due to upper motor neuron damage, resulting in poor coordination between bladder and sphincter.
47
Detrusor hyperreflexia
Uninhibited or reflex bladder activity, leading to increased urinary urgency and frequency.
48
Detrusor hyperreflexia with vesico sphincter dyssynergia
Condition where both the bladder and sphincter contract simultaneously, causing functional obstruction of the bladder outlet.
49
Lower motor neuron damage
Damage to neurons that directly innervate the bladder, leading to impaired signaling.
50
Detrusor areflexia
Underactive, hypotonic, or atonic bladder due to lower motor neuron damage, resulting in poor bladder contractions and retention of urine.
51
What is the location of an upper urinary tract obstruction?
Ureters and renal pelvis
52
What is the location of a lower urinary tract obstruction?
Bladder or urethra
53
What causes upper urinary tract obstructions?
Anatomic or functional defects; kidney stones, tumors, strictures
54
What causes lower urinary tract obstructions?
Anatomic defects; prostate enlargement, pelvic organ prolapse, urethral stricture
55
How severe are upper urinary tract obstructions?
Generally more severe; can directly affect kidney function
56
How severe are lower urinary tract obstructions?
Varies; can cause urinary retention but may not directly impact kidney function
57
What are the complications of upper urinary tract obstructions?
Hydroureter, hydronephrosis, tubulointerstitial fibrosis, postobstructive diuresis
58
What are the complications of lower urinary tract obstructions?
Urinary retention, bladder dysfunction, possible infection
59
What are the symptoms of upper urinary tract obstructions?
Flank pain, renal colic, hematuria, dysuria
60
What are the symptoms of lower urinary tract obstructions?
Frequent urination, urgency, nocturia, weak urine stream, feelings of incomplete emptying
61
How are upper urinary tract obstructions diagnosed?
History & physical exam, ultrasound, urodynamic tests
62
How are lower urinary tract obstructions diagnosed?
History & physical exam, imaging studies, urodynamic tests
63
What are anatomic obstructions to urine flow?
Physical blockages in the urinary tract
64
What can cause altered wound healing in the urinary tract?
Scarring that blocks or obstructs urine flow
65
What is a urethral stricture?
Narrowing of the lumen due to infection, injury, or surgical manipulation
66
What causes prostate enlargement?
Acute inflammation, benign prostatic hyperplasia, or prostate cancer
67
What is pelvic organ prolapse?
Downward protrusion of pelvic organs, such as the bladder into the vagina (cystocele)
68
What are the symptoms of anatomical obstructions?
Urinary retention, difficulty urinating, pain, or discomfort
69
How are anatomic obstructions diagnosed?
History & physical examination, imaging studies
70
What is the relationship between scarring and urinary tract obstruction?
Scarring can block or obstruct urine flow
71
What complications can arise from urethral stricture?
Increased risk of urinary tract infections and bladder dysfunction
72
How does prostate enlargement affect urine flow?
It can compress the urethra, leading to difficulty urinating
73
What are renal adenomas?
Encapsulated benign tumors usually found in the renal cortex
74
Can renal adenomas cause problems?
Yes, despite being benign, they can still lead to issues.
75
What is renal cell carcinoma (RCC)?
The most common renal cancer, accounting for 85% of cases, arising from proximal tubule epithelial cells.
76
What are some risk factors for renal cell carcinoma?
Tobacco use, obesity, and long-term analgesic use.
77
What are early manifestations of renal cell carcinoma?
Often asymptomatic, but can include unexplained weight loss and fatigue.
78
What constitutes the classic triad of renal cell carcinoma?
Hematuria, dull and aching flank pain, and a palpable flank mass (in thinner individuals).
79
How is renal cell carcinoma diagnosed?
Through history & physical examination, ultrasound, X-ray/CT/MRI, and IV pyelography.
80
What are the types of bladder tumors?
Papillary (attached to a stalk, tree-like growth) and non-papillary (more invasive with poorer prognosis).
81
What are risk factors for bladder tumors?
Smoking and exposure to aromatic amines used in dyes and pharmaceuticals.
82
What are common manifestations of bladder tumors?
Asymptomatic, hematuria, pelvic pain, and polyuria (frequent urination).
83
How are bladder tumors diagnosed?
Through history & physical examination, cystoscopy, and transurethral biopsy.
84
What is the most common pathogen causing urinary tract infections?
E. coli, responsible for 90% of UTIs.
85
What are other pathogens that can cause UTIs?
Staphylococcus saprophyticus, Klebsiella, and Proteus.
86
What is virulence in the context of uropathogens?
The ability to evade host defenses and cause disease.
87
How do uropathogens adhere to the uroepithelium?
They form colonies that are hard to clear from the urinary tract.
88
What ability helps uropathogens resist the host’s defenses?
The formation of biofilms that protect them from immune response.
89
What are common manifestations of a UTI?
Asymptomatic, urinary frequency, dysuria, urgency, flank and/or suprapubic pain, cloudy and foul-smelling urine, fever, and chills.
90
How is a UTI diagnosed?
Through history & physical examination, urinalysis, urine culture, and ultrasound.
91
What urine culture result indicates a UTI?
Counts of 10,000/mL or more of specific microorganisms.
92
What are some protective mechanisms of the urinary tract in women?
Mucus-secreting glands in the urethra trap bacteria.
93
What protective mechanism do men have against UTIs?
The length of the male urethra and secretions from the prostate and periurethral glands.
94
What role does the urethral sphincter play in preventing UTIs?
It acts as a mechanical barrier against infection.
95
How does the immune system contribute to urinary tract protection?
It responds to fight pathogens in the bladder.
96
What characteristics of urine help prevent pathogen survival?
Low pH and high osmolality of urea make it difficult for pathogens to survive.
97
What are glycoproteins' role in the urinary tract?
They create a slimy barrier that makes bacterial adherence difficult.
98
How does dilute urine help prevent UTIs?
It washes bacteria away from the urinary tract.
99
What is acute glomerulonephritis?
Inflammation of the glomerulus, often related to group A poststreptococcal infection.
100
When does acute glomerulonephritis usually occur after infection?
Abrupt onset, usually 7-10 days post strep throat or skin infection.
101
Who can be affected by acute glomerulonephritis?
It can occur in both adults and children.
102
What is the mechanism behind acute glomerulonephritis?
Antibodies against the strep organism cross-react with glomerular endothelial cells, activating complement and immune cells, leading to glomerular dysfunction.
103
How does acute glomerulonephritis affect GFR?
It leads to a decreased glomerular filtration rate (GFR).
104
What happens to glomerular perfusion due to inflammation?
There is a decreased glomerular perfusion (blood flow) as a result of inflammation.
105
What changes occur in the glomerular basement membrane?
There is thickening of the membrane, but increased permeability to proteins and red blood cells (RBCs).
106
What are common manifestations of acute glomerulonephritis?
Hematuria (with red blood cell casts), proteinuria (>3-5 g/day with albumin), hypoalbuminemia, edema, decreased GFR, and potentially oliguria and hypertension in severe cases.
107
How is acute glomerulonephritis diagnosed?
Through history & physical examination (H&P), urinalysis, serum creatinine, and creatinine clearance tests.
